Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study
- 1.2k Downloads
The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries.
Clinical and radiological data of 50 consecutive patients admitted at a single centre with a diagnosis of an acute traumatic thoracolumbar spine injury were distributed to eleven attending spine surgeons from six different institutions in the form of PowerPoint presentation, who classified them according to both classifications. After time span of 6 weeks, cases were randomly rearranged and sent again to same surgeons for re-classification. Interobserver and intraobserver reliability for each component of TLICS and new AOSpine classification were evaluated using Fleiss Kappa coefficient (k value) and Spearman rank order correlation.
Moderate interrater and intrarater reliability was seen for grading fracture type and integrity of posterior ligamentous complex (Fracture type: k = 0.43 ± 0.01 and 0.59 ± 0.16, respectively, PLC: k = 0.47 ± 0.01 and 0.55 ± 0.15, respectively), and fair to moderate reliability (k = 0.29 ± 0.01 interobserver and 0.44+/0.10 intraobserver, respectively) for total score according to TLICS. Moderate interrater (k = 0.59 ± 0.01) and substantial intrarater reliability (k = 0.68 ± 0.13) was seen for grading fracture type regardless of subtype according to AOSpine classification. Near perfect interrater and intrarater agreement was seen concerning neurological status for both the classification systems.
Recently proposed AOSpine classification has better reliability for identifying fracture morphology than the existing TLICS. Additional studies are clearly necessary concerning the application of these classification systems across multiple physicians at different level of training and trauma centers to evaluate not only their reliability and reproducibility, but also the other attributes, especially the clinical significance of a good classification system.
KeywordsAOSpine Thoracolumbar Spine Injury Classification System TLICS Reliability Thoracolumbar spine injuries
Compliance with ethical standards
Conflict of interest
None of the authors has any potential conflict of interest.
- 3.Bohler L (1930) Die techniek de knochenbruchbehandlungimgrieden und imkriege. Veralag von Wilhelm Maudrich. (in German) Google Scholar
- 13.Harrop JS, Vaccaro AR, Hurlbert RJ et al (2006) Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2005. J Neurosurg Spine 4:118–122CrossRefPubMedGoogle Scholar
- 19.Joaquim AF, Bastos DCDA, Torres HHJ (2015) Thoracolumbar Injury Classification and Injury Severity Score system: a literature review of its safety. Global Spine J. (Epub ahead of print) Google Scholar
- 21.Kepler CK, Vaccaro AR, Koerner JD, et al (2015) Reliability analysis of the AOSpine Thoracolumbar Spine Injury Classification System by a worldwide group of naïve spinal surgeons. Eur Spine J. (Epub ahead of print) Google Scholar
- 23.Landis JR, Koch GC (1977) The measurement of observer agreement for categorical data. Biometrics 36:207–216Google Scholar
- 29.Vaccaro AR, Schroeder GD, Kepler CK, et al (2015) The surgical algorithm for the AOSpine thoracolumbar spine injury classification system. Eur Spin J. (Epub ahead of print) Google Scholar
- 33.Blauth M, Bastian L, Knop C et al (1999) Inter-observer reliability in the classification of thoracolumbar spinal injuries. Orthopade 28:662–681 (in German) Google Scholar
- 36.Sadiqi S, Oner FC, Dvorak MF et al (2015) The influence of spine surgeon’s experience on the classification and intraobserver reliability of the novel AOSpine thoracolumbar spine injury classification system—an international validity study. Spine (Phila Pa 1976) 40(23):E1250–E1256CrossRefGoogle Scholar